Primary and secondary nocturnal enuresis

Question 1

What does enuresis mean?

Answer 1

Involuntary urination

Question 2

What is nocturnal enuresis?

Answer 2

Bed wetting

Question 3

What is diurnal enuresis?

Answer 3

Inability to control bladder function during the day

Question 4

By what age do most people have control of daytime urination?

Answer 4

2 years old

Question 5

By what age do most people have control of night time urination?

Answer 5

3-4 years old

Question 6

What is Primary nocturnal enuresis?

Answer 6

This is where the child has never managed to be consistently dry at night

Question 7

What is the most common cause of primary nocturnal enuresis?

Answer 7

Variation on normal development, particularly if the child is younger than 5 years.

Question 8

What is common with a child who has primary nocturnal enuresis?

Answer 8

A family history of delayed dry nights

Question 9

What is the management of a child younger than 5 with primary nocturnal enuresis?

Answer 9

Reassurance

Question 10

What are other possible causes of primary nocturnal enuresis?

Answer 10

Overactive bladder. .
Fluid intake prior to bedtime-
Failure to wake due to particularly deep sleep and underdeveloped bladder signals
Psychological distress-

Question 11

Drinking which fluids could result in primary nocturnal enuresis?

Answer 11

Fizzy drinks
Juice
Caffeine
(drinks with a diuretic effect)

Question 12

What psychological distress could result in primary nocturnal enuresis?

Answer 12

Low self esteem

Too much pressure or stress at home or school

Question 13

What is secondary nocturnal enuresis?

Answer 13

A child begins wetting the bed when they have previously been dry for at least 6 months.

Question 14

How long had the child be dry for before wetting the bed again with secondary nocturnal enuresis?

Answer 14

6 months

Question 15

What is secondary nocturnal enuresis more indicative of than primary nocturnal enuresis?

Answer 15

Secondary is more indicative of underlying illness than primary enuresis

Question 16

What are possible causes of secondary nocturnal enuresis?

Answer 16

• Urinary tract infection
• Constipation
• Type 1 diabetes
• New psychosocial problems (e.g. stress in family or school life)
• Maltreatment

Question 17

What is diurnal enuresis?

Answer 17

Daytime incontinence.

Question 18

When does diurnal enuresis occur?

Answer 18

When the person has become dry at night but still has episodes of urinary incontinence during the day.

Question 19

Who is more commonly affected by diurnal enuresis?

Answer 19

Girls

Question 20

What are the most common causes of diurnal enuresis?

Answer 20

Incontinence- Stress and Urge incontinence

Question 21

What are other possible causes of diurnal enuresis?

Answer 21

• Recurrent urinary tract infections
• Psychosocial problems
• Constipation

Question 22

What is the initial management of enuresis?

Answer 22

look for possible underlying causes/triggers
• constipation
• diabetes mellitus
• UTI if recent onset

Question 23

What is general advice for the management of enuresis?

Answer 23

• fluid intake
• toileting patterns: encourage to empty bladder regularly during the day and before sleep
• lifting and waking
• reward systems (e.g. Star charts)

Question 24

What is usually first line for children?

Answer 24

Enuresis alarm

Question 25

What is an enuresis alarm?

Answer 25

Have sensor pads that sense wetness and set off an alarm, waking the child up

Question 26

What drug management can be given if short term control is needed or the enuresis alarm doesn’t work?

Answer 26

Desmopressin

Question 27

What is the function of desmopressin?

Answer 27

It reduces the volume of urine produced by the kidneys